The Food & Drug Administration (FDA) has recently gained the authority to regulate tobacco products. Health warning label modifications have been proposed for cigarettes and smokeless tobacco (ST) product packaging, and will be allocated a portion of space within advertisements for these products. While numerous studies have demonstrated the effectiveness of larger, more graphic health warnings on promoting tobacco cessation in the population, there are few quantitative studies of the newly proposed health warning labels. Further, nearly all of the existing studies have focused on the health labels on product packaging without investigating these health warning labels within product ads. With an estimated $10 billion dollars in annual spending on cigarette and ST, ads remain a vibrant communication channel to reach tobacco users. This R01 application is responsive to PAR-12-010 (NIH Competitive Revision Applications for Research Relevant to the Family Smoking Prevention and Tobacco Control Act) and will be centered in Ohio Appalachia, a region characterized by economic disadvantage, lower educational levels, and high prevalence of smoking and ST. The purpose of this investigation is to evaluate the proposed warning labels embedded within tobacco product ads in order to assess their impacts on Ohio Appalachian smokers and ST users. This will be accomplished by recruiting current smokers (n=172) and current ST users (n=172) to complete an experimental study using eye tracking technology to capture detailed information about attention paid (measured by eye fixation time) to elements of the tobacco ad and health warning labels. Using an experimental design, participants will be randomly assigned an exposure to ads with the proposed FDA health warning labels or a larger health warning label (for smokers) or include graphic imagery (for ST users) to assess the impacts on attention, recall of health warning messages, perceptions of risk of tobacco use, tobacco cravings, cessation self-efficacy and cessation interest, or intent. Study findings are expected to yield critical information on the role of graphic health warnings on smokers and ST users from a high-risk, vulnerable population. Results may also directly inform policy decisions regarding the regulation of tobacco product ads. PUBLIC HEALTH RELEVANCE: The proposed study examines the impacts of the proposed health warning labels for cigarette and smokeless tobacco advertisements on Ohio Appalachian tobacco users. This experimental study will evaluate whether modifications to the characteristics of health warning labels embedded within advertisements can impact the attention, recall, perceived health risks, and cravings for tobacco products. Study results will serve to identify the effects of the proposed health warning labels within ads, and yield information about potential modifications that may offer greater public health protections by reducing the burden of tobacco-related disease in the population.